"Venous Thromboembolism Prophylaxis in Orthopedic Surgery: Main Report" (see also "Venous Thromboembolism Prophylaxis in Orthopedic Surgery: Appendices") - Major orthopedic surgery (total hip replacement, total knee replacement or hip fracture surgery) carries a high risk of venous thromboembolism. Pulmonary embolism following orthopedic surgery is reported to be rare. However, without prophylaxis, historical data suggest that hospital acquired deep venous thrombosis has been estimated to occur in 40 to 60 percent of cases in the 7 to 14 days following surgery compared with 10 to 40 percent among medical or general surgical patients. While asymptomatic deep vein thrombosis is identified more frequently than symptomatic deep vein thrombosis in clinical trials due to routine screening, there is disagreement as to the clinical relevance of asymptomatic cases. While certain patient characteristics (i.e. age, immobility, comorbidities) have been suggested to increase the risk of venous thromboembolism regardless of the clinical setting, major orthopedic surgery contributes additional factors such as use of general anesthesia which may prolong immobility and surgical involvement of the femoral vein. A variety of strategies to prevent venous thromboembolism are available and with routine use, the rate of symptomatic venous thromboembolism in patients within 3 months of surgery is 1.3 to 10 percent. The main limitation of pharmacologic venous thromboembolism prophylaxis is the risk of bleeding. Based on historical data major bleeding following total hip replacement and total knee replacement is estimated to be 1 to 3 percent. Determining the incidence of major bleeding with pharmacologic thromboprophylaxis is complicated by the variability in the definitions used in published literature and paucity of data in control patients. Following removal of an infected prosthesis and extended intravenous antibiotic treatment further surgery may be required to either implant a new prosthesis or perform an arthrodesis of the joint. There are many unknowns that need to be explored in a comparative effectiveness review. In contemporary practice, the risk of venous thromboembolism, pulmonary embolism, and deep vein thrombosis, and the causal link between deep vein thrombosis and pulmonary embolism has not been well established. Previous observations of the incidence of pulmonary embolism in patients who have undergone orthopedic surgery with confirmed deep vein thrombosis suggests that pulmonary embolism and deep vein thrombosis are related disorders. However, whether the presence of deep vein thrombosis affects the risk of pulmonary embolism and to what degree if so remains unclear in the literature. Widespread use of anticoagulants to treat venous thrombomebolism for many decades along with the evolution of diagnostic strategies have limited the availability of literature regarding the natural history of venous thromboembolism. In addition to major orthopedic surgery, there are a variety of other orthopedic surgeries in which the impact of venous thromboembolic prophylaxis has not been well evaluated. These orthopedic surgeries of interest include knee athroscopy, surgical repair of lower extremity injuries distal to the hip, and elective spine surgery. While prophylactic strategies may decrease the risk of venous thromboembolism, pulmonary embolism, and deep vein thrombosis, the magnitude of benefit in contemporary practice using rigorous definitions of endpoints and the impact of duration of prophylaxis on outcomes is not well delineated. Whether dual prophylactic strategies are superior to a single modality is not well defined. In addition, in order to determine comparative effectiveness, both the benefits and harms need to be appreciated. Finally, several previous meta-analyses and guidelines allowed the use of medications or devices that are not available for use in the United States reducing their applicability.

This book brings forth an extensive look at the recent advances in the most performed arthroplasties of large joints of lower parts. The remedial choices in degenerative joint ailments have progressed very quickly. Various surgical methods are available,

Showcasing the expertise of top-tier specialists who contributed to the newly released guidelines for the care of thrombosis in cancer patients, this exciting guide was written and edited by members of the American Society of Clinical Oncology panel, (ASCO), on the prevention and treatment of cancer-associated thrombosis, among others, and provides

Written by experts at the top-ranked Hospital for Special Surgery in New York, Perioperative Care of the Orthopedic Patient is a comprehensive, multidisciplinary manual providing preoperative considerations, postoperative complications, and guidelines for the anesthetic and medical management of patients undergoing orthopedic surgery. Beginning with chapters covering preoperative evaluations and general principles and practices of perioperative medicine, the book then considers anesthesiologic management in orthopedic surgery and the role of postoperative pain management. This is followed by a section on medical management in specific clinical settings, discussing patients with connective tissue disease, cardiac disease, chronic pulmonary and renal diseases, diabetes and psychiatric and neurological diseases. A fourth section covers specific perioperative problems in orthopedic surgery, such as care of the elderly patient, venous thromboembolism, infection, nutrition, compartment syndrome, and bone health. Finally, the role of allied services, quality improvement and ethics are highlighted, and selected case studies are included to illustrate real-world perioperative issues and management strategies in orthopedic surgery. A comprehensive yet concise reference, Perioperative Care of the Orthopedic Patient will be an invaluable resource for orthopedic surgeons, sports medicine specialists and any professional involved in orthopedic surgery.

This book provides a practical guide to the use of novel and conventional anticoagulants for a variety of medical conditions and patients profiled. It reviews data for selecting the most appropriate medication for a given presentation based on a patient’s background while highlighting current best practices. Chapters discuss the choice of agents and optimum duration of therapy while including the relevant literature review and evidence. Specific sections focus on the use of anticoagulants in patients with cardiovascular disease, autoimmune and rheumatologic disorders, antiphospholipid syndrome, cancer, and in the surgical contexts. The book also examines anticoagulation in pregnant and lactating women, pediatric and elderly populations, and patients with extreme weights. Intended for use in daily practice, Precision Anticoagulation Medicine - A Practical Guide is an essential resource for physicians and related professionals, residents, fellows, and graduate students in hematology, cardiology, rheumatology, oncology, surgery, anesthesiology, and intensive care.

Evidence-Based Orthopedics is an up-to-date review of the best evidence for the diagnosis, management, and treatment of orthopedic conditions. Covering orthopedic surgery as well as pre- and post-operative complications, this comprehensive guide provides recommendations for implementing evidence-based practice in the clinical setting. Chapters written by leading clinicians and researchers in the field are supported by tables of evidence that summarize systematic reviews and randomized controlled trials. In areas where evidence is insufficient to recommend a practice, summaries of the available research are provided to assist in decision-making. This fully revised new edition reflects the most recent evidence using the approved evidence-based medicine (EBM) guidelines and methodology. The text now places greater emphasis on GRADE—a transparent framework for developing and presenting summaries of evidence—to allow readers to easily evaluate the quality of evidence and the strength of recommendations. The second edition offers a streamlined presentation and an improved standardized format emphasizing how evidence in each chapter directly affects clinical decisions. Incorporating a vast amount of new evidence, Evidence-Based Orthopedics: Features thoroughly revised and updated content, including a new chapter on pediatric orthopedics and new X-ray images Provides the evidence base for orthopedic surgery as well as pediatric orthopedics and orthopedic conditions requiring medical treatment Covers the different methods for most orthopedic surgical procedures, such as hip replacements, arthroscopy, and knee replacements Helps surgeons and orthopedic specialists achieve a uniform optimum standard through a condition-based approach Aligns with internationally accepted guidelines and best health economic principles Evidence-Based Orthopedics is an invaluable resource for orthopedic specialists, surgeons, trauma surgeons, trainees, and medical students.